10 Questions with Eliot Siegel, MD, FACR, FSIIM

August 18, 2014

For this “10 Questions” series, we spoke with Eliot Siegel, MD, FACR, FSIIM, about his work and the future of radiology.

Our “10 Questions” series asks the same questions to a diverse group of professionals in the medical imaging community.

Here, we profiled Eliot Siegel, MD, FACR, FSIIM.

1. Please state your name, title and the organization you work for.

Eliot Siegel, MD, FACR, FSIIM. I am professor and vice chair of research information systems for the University of Maryland Department of Diagnostic Radiology and Nuclear Medicine as well as chief of imaging for the VA Maryland Healthcare System. I am also an adjunct professor of computer science and adjunct professor of biomedical engineering at the University of Maryland.

2. How did you get where you are today?

By having the Forest Gump–like serendipitous good fortune to be in the right time at the right place to take advantage of extraordinarily interesting, fun and challenging opportunities –– such as designing a new radiology department in a new hospital when I was fresh out of fellowship and making it the world’s first filmless radiology department, working with the IBM Jeopardy! team to help them apply their technology to medicine and many others. The best part of my good fortune has been the freedom to dedicate my career to anticipating the next curve in the road for radiology and medicine, with an eye on planning for technological innovation.

3. Why did you choose your profession?

My background as an undergraduate was in the physiology and psychology of human vision, including the study of computer vision and optical illusions. I was drawn to these fields, I think, because of the limitations of my own visual memory (compared to numbers, concepts or facts). Diagnostic radiology turned out to be a perfect choice in medical school, especially because it seemed to be the specialty with the greatest potential to be radically changed by advances in technology and the one that was most involved with the art and science of human visual perception.

4. What is your biggest day-to-day challenge?

Time management, just like everyone else: keeping up with family and puppy, e-mails, meetings, travel, mentoring appointments, administrative tasks, research and writing deadlines, and clinical responsibilities –– and getting in some time for tennis and basketball. Despite attempts at advance planning, the way I think my day will go when driving into work in the morning most often is entirely different from the way it actually turns out.[[{"type":"media","view_mode":"media_crop","fid":"27068","attributes":{"alt":"Eliot Siegel","class":"media-image media-image-right","id":"media_crop_6661929003385","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2597","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 194px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

5. What worries, if any, do you have about the future of radiology? If none, where do you think the field is going?

I have plenty of concerns about the future of radiology, as we all do, including the obvious: declining reimbursement, implications of the transition from “profit” to “cost center” infrastructures, and competition from other specialties that are incorporating image interpretation and image-guided procedures into their basic residency and fellowship training. But I also worry about radiology losing its interest and/or ability to stay nimble and adapt to current social, economic, and political changes in health care. I am also very concerned that we are becoming too insular and that we may be lost in the evolving era of “big data,” in which the quality of clinical care and the way in which medicine is practiced will be predicated on analysis of objective, quantifiable, and discoverable data. As decisions in medicine are increasingly being made in a non-anecdotal manner utilizing personalized/precision medicine incorporating genomic, proteomic, laboratory and historic data, radiology needs to make its interpretations and measurements much easier to find and utilize in patient care.

We are in danger of being marginalized in a future where decisions are made by algorithms that are unable to take advantage of the rich information that radiology provides because we are not making it easy to discover simple questions, such as “Was the study positive for the reason it was requested?”, “Are there incidental findings?”, “What further imaging should I do and when?”, “How sure are you?” and “What does it mean?” We risk commoditization by emphasizing things such as report turnaround times over quality, and we have a really hard time agreeing on the basics, such as what constitutes a quality report. But, overall, I’m really optimistic about our field.

Personalized/precision medicine will bring on a new era in more carefully targeting screening exams and requests for tissue samples, which will constitute a substantial growth area in the future. We’re only now beginning to discover the potential to unlock the mystery of the brain using imaging, and more effective emerging treatments for dementia, depression and affective and other cognitive diseases will be major foci of imaging advances. An emphasis on wellness and life extension, including quality of life and “proactive medicine,” will constitute a large chunk of our future imaging studies. We will adapt, evolve and re-invent our profession and our role in medicine over the next decade.

6. What one thing would make your job better?

The first thing that comes to mind would be if I could find a magic ray gun that would help bring back the sense of adventure, enthusiasm, creativity, discovery and joy that we experienced when we were eight years old. I see quite a lot of this in the undergraduates with whom I work, a fair amount in medical students, vestiges in our residents and fellows and occasional flashes in our attending radiologists and colleagues. If that ray gun isn’t available, I’d settle for a PACS and speech recognition system that was smarter than a fifth grader.

7. What is your favorite thing about radiology?

I love the way that radiology has consistently and dynamically re-invented itself, especially over the past 25 years. Hybrid modalities, such as PET/CT/MR imaging; the shift toward functional imaging, especially of the brain; the emergence of digital imaging technologies that make computer-aided detection and diagnosis feasible; and rapid expansion of our knowledge base and imaging resources make radiology even more exciting than it was when I chose it as a profession. I can’t think of any field in health care that would come in as even a close second.

8. What is your least favorite thing about radiology?

My least favorite thing about radiology is (perhaps ironically) our image. We’ve accomplished so much in recent years but have made little progress in the perception of our specialty by either our clinical colleagues or, more important, our patients. I wish our efforts to get the word out about how diagnostic imaging has become absolutely indispensible and completely changed the practice of medicine and surgery for all patients could match the acute surge in public awareness about risks associated with radiation. This should, of course, be addressed at both the level of our major radiology societies and at the individual level. The medical school student’s stereotype of the radiologist has “evolved” from that of the goggle eyed hermit sitting in the darkened basement to the isolated, non-communicative recluse reviewing images in a plush office at home or work. We could do so much more to reach out to our clinical colleagues and patients to communicate our fascination with our specialty and genuine concern and interest in our patients.

9. What is the field’s biggest obstacle?

Radiology’s biggest obstacle, in my opinion, is our increasing lack of cohesiveness, despite all of the commendable efforts of the ACR, RSNA and other organized societies. In a time of increasing challenges, there seems to be less esprit de corps than in past years. It is difficult to send a consistent, solid message to our legislators, clinical colleagues and patients when we cannot agree about our own goals. As Seneca, the Roman Stoic philosopher, tutor and advisor to Nero, observed, “If a man knows not to which port he sails, no wind is favorable.” 

10. If you could give the radiology industry one piece of advice, what would it be?

Embrace change and self-reflection. Come into work next Monday morning, take a 10-minute time out, and try to step out of your routine and ask yourself about how things could be improved. Think literally and figuratively out of the box in which you work, starting with the chair you are sitting in.  Start by re-evaluating your desk, lights and room acoustics.

Ask yourself every once in a while, what do I want to be doing in five or 10 or 20 years? Where do you think our specialty will be at that point in time?

Embrace or at least bump fists with a radiologist born after 1985 and listen to his or her perspective. Our 20-something-year-olds are positive, confident, expressive and adaptable. Before we know it, they will take the reins of our profession. That is one of many reasons I remain optimistic about radiology’s image, future and ever-changing role in the practice of medicine.

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